The political fiasco that unfolded last week as President Donald Trump and the Republican House leadership failed to pass legislation repealing the Affordable Care Act, commonly called Obamacare, is attributable as much to the failure of politics as it is to the failure of politicians to understand the constitutional role of the federal government.

Republicans could not muster a majority in the House, which they control, because a determined small group of them want to remove the federal government from the regulation of health care and believe that the replacement for Obamacare that House leaders have offered would keep too much of it in place. The president and his allies have argued that their bill would invalidate enough of Obamacare to return free choices to health care and to fulfill their campaign promises.

Neither side has prevailed.

Here is the back story.

When Congress passed Obamacare in 2010, it did so without a single Republican vote. The premise underlying the highly partisan 2,700-page legislation is that health care is a right belonging to everyone in America and the federal government has a constitutional duty to provide it.

The political structure of Obamacare mandates that every person in America obtain health insurance, that every employer of more than 50 people in America pay for the health insurance of all employees who work more than 30 hours per week, that every policy of health insurance cover a large dimension of potential medical needs and that those earning under a certain annual income level receive health care at the expense of the rest of us. The failure to obtain and maintain health insurance triggers a tax burden — equivalent to the annual premium on a health insurance policy — for every year one goes without coverage.

The economic structure of Obamacare requires 100 percent participation of everyone in America so as to ensure a large pool of insurance premiums — whether paid by individuals, employers or taxpayers — from which to pay health care providers. Still, premiums don’t cover costs, which is why President Trump says Obamacare is collapsing.

The regulatory structure of Obamacare orders every primary care physician to keep all medical records on personal computers, to which the Department of Health and Human Services has access. Thus, the long-revered and uniquely American value of the patient-physician privilege — the certain knowledge that your doctor will not reveal what you tell her or him — has been obliterated. The statute also has given the secretary of HHS unreviewable powers to regulate intricacies of the delivery of health care in America.

Along with this expensive and bitter medicine — which has caused hundreds of thousands of folks to downgrade to part-time work, reduced the wages of millions more and driven thousands of health care providers into retirement or new occupations — Obamacare also has provided some sugar. The statute orders insurance carriers to cover pre-existing conditions, children on their parents’ policies up to the age of 26 and expensive elective procedures, such as abortions and sex reassignment.

After the Republicans acquired full control of Congress in 2015, they delivered numerous repeals of Obamacare to President Barack Obama, knowing that he’d veto them, which he did. These were complete repeals — essentially removing the federal government from the regulation of health insurance and the delivery of health care.

Now that Republicans control Congress and the White House, you’d expect that they would do the same, as they have promised. No such thing has happened. The legislation that Republican House leaders offered last week retained the basic premise of Obamacare — that health care is a right and the federal government has a duty to provide it — and just nibbled a bit at the edges.

Under the House proposal, the obligation to have health insurance would remain, but you couldn’t expect it from your employer; you might have to pay for it yourself. And the penalty for the failure to have coverage would not be a tax from the IRS; it would be a $3,000 annual surcharge from your insurance carrier when you sign up. You could buy insurance tailored to your needs, but nearly all remaining federal regulations would stay in place — including a new Orwellian one that would permit your employer to require you to undergo genetic screening.

This Obamacare lite has been resisted by about 30 House Republicans who reject the premise that health care is a right. Without their votes, it would not have passed last week, so the House leadership declined to hold a vote.
Is health care a right in America?

In a word, no. Rights are either natural immunities — existing in areas of human behavior that, because of our nature, must be free from government regulation, such as life, liberty and the pursuit of happiness, as well as speech, the press, religion, travel, self-defense and what remains of privacy — or legal claims that we qualify or bargain for, such as the right to vote, which the Constitution presumes, and the right to use your property to the exclusion of all others and the right to purchase a good that you can afford.

But the federal government cannot create a right that the Constitution does not authorize. It can’t constitutionally transfer wealth from taxpayers or employers to others and then claim that the others have a right to the continued receipt of the transfers. The Supreme Court has ruled that even Social Security, Medicare and Medicaid are government largesse that Congress could terminate because no one has a right to them.

Of course, the federal government has been creating expectations that it calls rights for centuries. To stay in office, members of Congress bribe the rich with bailouts, the middle class with tax cuts and the poor with made-up rights to all sorts of things.

Yet under the Constitution, health care is not a right; it is a good — like an education or a gym membership. You work hard, you decide what goods to purchase. If government gives you the good, that does not magically transform it into a right.

"It’s about rent seeking and corruption." I can't disagree. The American Medical Association's threats to have its state-licensed practitioners quit practice unless the AMA gets what it wants have been a staple of American health care debate since the 1930s. Many among the American public still believe the AMA's political stance is rooted in the cause of good medicine, because physicians, as do teachers, enjoy such good political cover within a helping profession..

There's so much bad faith in health care debate it's difficult to join issues. But, Judge Napolitano, whom I respect, may want to also ask: (1) do Americans have a right to withdraw from group health insurance plans in which their employer compulsorily enrolls them? (2) If so, do those employees have a right to receive cash payment equal to the cost of the premiums that had been paid for them? (3) And, if so, should those payments be taxed as ordinary income? (4) Is there any example of a wage- or salary-earner who has attempted to remove himself from a group health insurance roll? (5) Is there any example of someone who has failed to remove himself from a group health insurance roll, and regards that as a cause for political grievance?

Many will say the insurers are the culprit. Wrong. The ACA specifically caps insurer's profits at 20% of the claims they pay on behalf of their customers. If the insurers collect more premium dollars than 1.2 X their claims payments they must refund the excess to their customers.

Since the implementation of the ACA virtually all insurers in my home state of Texas have issued refunds to their customers for premiums collected in excess of this profit limit. I suspect the same is true of other states.

So, why then is the ACA collapsing under its own weight? Why are deductibles and premiums rising so fast? Why are the best plans available on and off the Exchanges becoming utterly unaffordable? Why are people then buying (under threat of penalty) very disabled plans that cover almost nothing but catastrophic care (Bronze plans) instead of competent policies that match their health status and histories and allow them to see a physician inexpensively for day to day care?

Here's a shocker. The medical arts providers CHARGE TO DAMNED MUCH FOR THEIR SERVICES.

Your doctor, the hospital or clinic in which he / she works, the handy ER center, the laboratories, the medical device and pharmaceutical companies, imaging clinics, etc. gouge you to death with their prices. And, the ACA only made the system worse because the 20% cap on insurance profits on and off the Exchanges did two things, it assured the insurers a steady profit and it removed the incentive of the insurers to try to control the costs of care by the providers.

Stupid, huh?

But make no mistake. The providers were handed a right to extort by the ACA and they employed it to enrich themselves far beyond their wildest dreams.

Without cost controls on the providers no national healthcare scheme will succeed. Medicare and Medicaid have some provider cost controls but they are by no means powerful enough to end the extortion of the providers who operate what amounts to the old stage coach robbers demand, "Your money or your life."

Of course, this has been happening for many decades. And, eliminating the free market for healthcare services right after WWII by inserting the middle man insurers made it a managed market where the cost of the sick is born by all. This, in turn, insulated the providers from any price pressure and made the insurers the absolutely best thing that could ever happen to their profits.

You can bet they took advantage of it and will continue to do so until effective cost controls are in place.

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Lol what isn't a right on someone else's labor, what right does the IRS have to tax my labor what right does the state or county have to tax my labor, or is what your saying is that the government has a right to my labor and no one else.Hmm strange way of thinking methinks..

Mr. Napolitano offers an excellent outline of the libertarian position on this issue. Fine. But if he really hopes to persuade people, he (like so many other fundamentalists of liberty) should learn to at least listen to the desires of the people he’s trying to persuade. The Obamacare bill was advertised as trying to remedy many unpleasant things that many Americans really don’t want: getting excluded from coverage for pre-existing conditions et cetera. Napolitano’s policy may indeed be the best for America, but it will never be adopted if he and its other proponents never learn to escape the implausible (at least to nonbelievers) notion that What-The-Market-Decides = What-Is-Good.

The problem is that for most people What-Is-Good = What-Is-My-Right. But merely wanting or even needing something does not entail a right to it. Sadly, this is not recognized by our leaders. Witness all the positive "rights" to the labor of others listed in the UN declaration of human rights.

The health care racket is extralegal. It's about rent seeking and corruption. It's not about rights or goods. From the point of view of the American people, it's extortion.

“It’s about rent seeking and corruption.” I can’t disagree. The American Medical Association’s threats to have its state-licensed practitioners quit practice unless the AMA gets what it wants have been a staple of American health care debate since the 1930s. Many among the American public still believe the AMA’s political stance is rooted in the cause of good medicine, because physicians, as do teachers, enjoy such good political cover within a helping profession..

There’s so much bad faith in health care debate it’s difficult to join issues. But, Judge Napolitano, whom I respect, may want to also ask: (1) do Americans have a right to withdraw from group health insurance plans in which their employer compulsorily enrolls them? (2) If so, do those employees have a right to receive cash payment equal to the cost of the premiums that had been paid for them? (3) And, if so, should those payments be taxed as ordinary income? (4) Is there any example of a wage- or salary-earner who has attempted to remove himself from a group health insurance roll? (5) Is there any example of someone who has failed to remove himself from a group health insurance roll, and regards that as a cause for political grievance?

A Right or A Good?
It is simply a decision a society makes for itself.
Police protection, fire departments, a military, space EXPLORATION.
Private, profit-extorting entities or our govt?
Maybe time for The People to actually receive a benefit for tax dollars

The health care racket is extralegal. It's about rent seeking and corruption. It's not about rights or goods. From the point of view of the American people, it's extortion.

Yes, but under the ACA who’s the extortionist?

Many will say the insurers are the culprit. Wrong. The ACA specifically caps insurer’s profits at 20% of the claims they pay on behalf of their customers. If the insurers collect more premium dollars than 1.2 X their claims payments they must refund the excess to their customers.

Since the implementation of the ACA virtually all insurers in my home state of Texas have issued refunds to their customers for premiums collected in excess of this profit limit. I suspect the same is true of other states.

So, why then is the ACA collapsing under its own weight? Why are deductibles and premiums rising so fast? Why are the best plans available on and off the Exchanges becoming utterly unaffordable? Why are people then buying (under threat of penalty) very disabled plans that cover almost nothing but catastrophic care (Bronze plans) instead of competent policies that match their health status and histories and allow them to see a physician inexpensively for day to day care?

Here’s a shocker. The medical arts providers CHARGE TO DAMNED MUCH FOR THEIR SERVICES.

Your doctor, the hospital or clinic in which he / she works, the handy ER center, the laboratories, the medical device and pharmaceutical companies, imaging clinics, etc. gouge you to death with their prices. And, the ACA only made the system worse because the 20% cap on insurance profits on and off the Exchanges did two things, it assured the insurers a steady profit and it removed the incentive of the insurers to try to control the costs of care by the providers.

Stupid, huh?

But make no mistake. The providers were handed a right to extort by the ACA and they employed it to enrich themselves far beyond their wildest dreams.

Without cost controls on the providers no national healthcare scheme will succeed. Medicare and Medicaid have some provider cost controls but they are by no means powerful enough to end the extortion of the providers who operate what amounts to the old stage coach robbers demand, “Your money or your life.”

Of course, this has been happening for many decades. And, eliminating the free market for healthcare services right after WWII by inserting the middle man insurers made it a managed market where the cost of the sick is born by all. This, in turn, insulated the providers from any price pressure and made the insurers the absolutely best thing that could ever happen to their profits.

You can bet they took advantage of it and will continue to do so until effective cost controls are in place.

The only people in the US with unlimited, speedy access to health care in the US are the 1% , who can afford to pay for any health care required out of their own pockets. The rest of you Americans are subject to politically unaccountable gatekeepers or Death Panels called insurance companies, who determine what is covered or not.
In countries with universal taxpayer funded Medicare, it is similar. Only the rich get unlimited, speedy access to health care. If necessary, they will go out of country. The rest of the population are subject to provincial (e.g., Canada) or national (e.g., Britain) gatekeepers or Death Panels, who determine what is covered or not available in the system.
In some countries like Switzerland, the health care system is a dual one. Insurance is mandatory. So if you are healthy without any preconditions, insurance companies compete to give you coverage. Otherwise, if someone is not healthy with preconditions, the government covers him/her. Since the government is not in the insurance business, such an individual can get a standard policy from any insurance company, who acts as administrator, passing on the costs plus administration fees to the government for any medical procedures. However, to ensure that the government is paying a fair charge, it audits the costs of these individuals vs the general populaton.

Well unless you can let hospitals refuse care to emergency poor patients and let them die in front of the emergency room door, then your libertarian wet dream cannot happen. The laws stating that people MUST be served and stabilized by any hospital mean that healthcare is already considered a right.

If we all have a right to it, we all have a responsibility to pay for it as well. Unfortunately, the model breaks down when so many people cannot pay a penny into the system. This is another side effect of our ridiculous 1% centered immigration policy. The wages of people paying into the system stagnate while the fees and prices charged by those in the medical industry rise.

The Constitution apparently mandates gay marriage and a recently discovered right of non-citizens to be free from religious discrimination when they apply for a visa. The Constitution apparently permits Departments of Education, Labor, Commerce, Energy, Transportation, standing armies, indiscriminate spying on citizens, etc.

I am not concerned with Constitutional arguments at this point. The Constitution means whatever the government wants it to mean.

We have socialized medical coverage for old people, poor people, the military, and federal, state and municipal employees. What is the argument against extending some level of medical coverage to everybody else, like the rest of the industrialized world does?

Perhaps a lot of people don't want socialized medicine since it results in long waiting times and shortages. Why otherwise do Canadians come to the US to get timely medical service and avoid the waits in their socialist paradise? The problem is that healthcare is a scarce good and merely labeling it a right doesn't alter that fact. There is not enough to go around for everybody, so you either let the price system determine how to allocate resources or you let the government ration it.

No, Americans appeal to the Constitution. What was written on that piece of paper is what they believe.

Amusingly enough, the words were written in the age of enlightenment, when man stopped treating holy books as the word of God.

Instead, Americans worship the word of the Constitution.

Notice that America has the highest percentage of religious fanatics and fundamentalists in the developed world who literally and sincerely believe an ancient fairy-tale book written 2000-3000 years ago (not to mention such fakes as the Book of Mormon). No wonder they are stubbornly fixated on a piece of paper written just 250 years ago. Americans are outstandingly and ridiculously obstinate.

Throughout our history, sick and injured poor people got care in America, just as they got food and shelter. That was a choice made by their friends, family, and caregivers, not a mandate from the State. No, moneyless jackasses who had no friends did not get expensive treatments, but they got their broken legs set, their abscesses drained and their rotten teeth pulled. Once you declare medical care to be a right, the Salvadorean car thief in prison has just as much right to cancer treatment as a 30 year old American mother of four. And the tax-paying husband of the mother of four will have to pay for it.

You do realize that it's possible to care for your sick without declaring that the sick have a right to care, right? And also that in "primitive societies" it was usual to abandon infants and the elderly and others that were a burden on others, just as in Britain people are put on long waiting lists to receive care if the government decides they are not a priority.

Healthcare can't be a right because it's a scarce good. There isn't enough to satisfy everybody's wants or needs, so if the system runs out of resources, it does no good to complain that you have a "right" to a service that simply does not exist.

The federal government takes in annual revenue of $3.6T a year. The total for all states is $2T and municipal is $1.4T. Out of all that, we manage to fund the healthcare of the poor, the elderly and all government employees. This is just an issue of priorities and policy.

I’m here to join in the Brit above who commented that all this sounds so strange to Brits. It sounds strange to a Canadian, too. Here’s the deal: around here, health care is just not an issue. We don’t argue about it (much); we don’t talk about it; we don’t worry about it. It just happens.

Nobody goes bankrupt. Nobody goes without.

I’m well into the 1%, at least in terms of assets, and I pay substantial taxes, but I really think this is money well spent. Why? Because nobody around here, not my employees, not me, not my relatives, not the people I meet on the street, ever has to worry about health care.

You know the only time I have to agonize over a medical bill? When I take my dog to the vet. That’s bad enough for me. I can’t imagine what it would be like if I had to do that for a family member.

There are enough problems in life. You guys just don’t see how much easier life is when you take this one off the table.

Sure it’s not a right. Neither are roads, or water, or electricity. But life is better when you have them.

That’s all I’d argue. Universal health care just makes a whole lot of simple, basic, practical sense, whether it’s a right or not. It just makes for a better life for everybody.

Duglarri, I'm pretty sure the Congressional inquiry that precedes any American national health care scheme will underscore some of the same points you've made. How much political focus and moral clarity have been squandered for decades by revisiting the same questions over and over again without a satisfactory resolution? The reality is that most Americans have health care paid for them by collectivized actuarial schemes that have been patched together willy-nilly to serve the political ends of specific players. They simply don't wish to believe they're the beneficiary-pawns of someone else's political design.

We'll end up with a Medicare for All scheme. (Our Medicare now starts only at age 65.) The business of taking down America's medical establishment to open up political space for MfA will, I suspect, be a pretty ugly business.

Yours is one of the wisest comments I've ever read here on the issue. But Americans will never understand. As I once said whatever problems and sufferings their health care system causes for them they deserve every bit of it. Maybe when they will have suffered enough they will understand what others understood 50 or more years ago. As the saying goes, a wise man learns from others' mistakes, a fool learns from his own.

Eventually some form of a single-payer system will emerge in America. In essence it'll become Universal Medicare, with some kind of a lifetime cap. Is it the answer? No. When it comes to health care financing (and forget the word "insurance" because you can't insure a person's health) the free market system is simply not very efficient. Though I am a small-government person, I don't see any other way out of what has become a hopeless mess.

That’s all I’d argue. Universal health care just makes a whole lot of simple, basic, practical sense, whether it’s a right or not. It just makes for a better life for everybody.

Exactly. Putting economic concerns aside, private health insurers are just an utter pain to deal with. I worked at an insurance brokerage firm, and we frequently had to go back-and-forth with major insurance carriers such as Anthem, UHC, and Cigna, just to name a few. Despite having trusted representatives from each carrier who helped us resolve employees' questions about claims, coverage, etc, it was still an aggravating and time consuming process. I can only imagine what it's like for regular members who don't have trusted representatives at their disposal. Oh, and getting back to economics, all these insurance representatives that review claims and determine covered services don't work for free. Libertarians who think that the public sector has a monopoly on wasteful bureaucracy know nothing about private health insurance.

Also, I agree with the British commenter re: Constitution fetishization. Somehow, this hallowed document hasn't stopped the NSA from spying on us, the US from maintaining hundreds of military bases around the world, the assault on Habeas Corpus, civil asset forfeiture, or various other abuses of power. If THE CONSTITUTION is simply whatever five unelected attorneys in robes say it is, then it's no better than a piece of paper.

What Libertarians like Napolitano fail to understand is that most people don't give a damn about "the free market," "The Constitution," or other Randroid/True Conservative bromides; they care about what helps them live better lives, and universal healthcare does just that. One might even say it makes the pursuit of happiness a happier process.

Sure it’s not a right. Neither are roads, or water, or electricity. But life is better when you have them.

That's right. And you can add in garbage disposal. Having spent some time in Haiti, I can vouch for what "small government" really looks like when taken to its logical extreme. After the earthquake in 2010 I was able to clamber around in the ruins of destroyed buildings, see corpses everywhere, and never saw a single piece of yellow plastic tape or a police car, except one time I saw a UN armored car causing a traffic jam by driving on the wrong side of a divided highway, and Anderson Cooper causing a minor traffic jam.

I agree with you about dropping the silly "rights" rhetoric and simply regard healthcare as a good that could be paid for by government rather than private providers. However, I think you are empirically mistaken when you say that nobody in Canada goes without healthcare. Did you know that many Canadians travel to the US to get healthcare because they cannot get certain services in Canada, or have to wait too long to get those services? This is to be expected, because healthcare is a scarce good; there is not ever enough to satisfy everybody's wants. Either the market allocates the scarce resources through the pricing mechanism, or the government has to use some rationing scheme, which includes denying some services or forcing people to wait for others.

I honestly think much of this superiority you feel about the Canadian system comes from the illusion that you have universal care. You don't. You have universal coverage which means that, if the government decides to let you use a service, you will not be billed for it directly. Now I can see how that provides some psychological relief and sense of security, but don't pretend that it's something it's not.

I'm here to join in the Brit above who commented that all this sounds so strange to Brits. It sounds strange to a Canadian, too. Here's the deal: around here, health care is just not an issue. We don't argue about it (much); we don't talk about it; we don't worry about it. It just happens.

Nobody goes bankrupt. Nobody goes without.

I'm well into the 1%, at least in terms of assets, and I pay substantial taxes, but I really think this is money well spent. Why? Because nobody around here, not my employees, not me, not my relatives, not the people I meet on the street, ever has to worry about health care.

You know the only time I have to agonize over a medical bill? When I take my dog to the vet. That's bad enough for me. I can't imagine what it would be like if I had to do that for a family member.

There are enough problems in life. You guys just don't see how much easier life is when you take this one off the table.

Sure it's not a right. Neither are roads, or water, or electricity. But life is better when you have them.

That's all I'd argue. Universal health care just makes a whole lot of simple, basic, practical sense, whether it's a right or not. It just makes for a better life for everybody.

Duglarri, I’m pretty sure the Congressional inquiry that precedes any American national health care scheme will underscore some of the same points you’ve made. How much political focus and moral clarity have been squandered for decades by revisiting the same questions over and over again without a satisfactory resolution? The reality is that most Americans have health care paid for them by collectivized actuarial schemes that have been patched together willy-nilly to serve the political ends of specific players. They simply don’t wish to believe they’re the beneficiary-pawns of someone else’s political design.

We’ll end up with a Medicare for All scheme. (Our Medicare now starts only at age 65.) The business of taking down America’s medical establishment to open up political space for MfA will, I suspect, be a pretty ugly business.

We do understand that Americans have a curious aversion for caring for their sick, but that is their choice.

No, what is strange is the Amercian conception of rights.

They say it is their right to carry guns, have free speech and be tremendously fat. They also say it is their right to murder anyone anywhere on the planet.

How they justify this is not by some, strange appeal to reason.

Amercians generally don't think in that way.

No, Americans appeal to the Constitution. What was written on that piece of paper is what they believe.

Amusingly enough, the words were written in the age of enlightenment, when man stopped treating holy books as the word of God.

Instead, Americans worship the word of the Constitution.

No, Americans appeal to the Constitution. What was written on that piece of paper is what they believe.

Amusingly enough, the words were written in the age of enlightenment, when man stopped treating holy books as the word of God.

Instead, Americans worship the word of the Constitution.

Notice that America has the highest percentage of religious fanatics and fundamentalists in the developed world who literally and sincerely believe an ancient fairy-tale book written 2000-3000 years ago (not to mention such fakes as the Book of Mormon). No wonder they are stubbornly fixated on a piece of paper written just 250 years ago. Americans are outstandingly and ridiculously obstinate.

I'm here to join in the Brit above who commented that all this sounds so strange to Brits. It sounds strange to a Canadian, too. Here's the deal: around here, health care is just not an issue. We don't argue about it (much); we don't talk about it; we don't worry about it. It just happens.

Nobody goes bankrupt. Nobody goes without.

I'm well into the 1%, at least in terms of assets, and I pay substantial taxes, but I really think this is money well spent. Why? Because nobody around here, not my employees, not me, not my relatives, not the people I meet on the street, ever has to worry about health care.

You know the only time I have to agonize over a medical bill? When I take my dog to the vet. That's bad enough for me. I can't imagine what it would be like if I had to do that for a family member.

There are enough problems in life. You guys just don't see how much easier life is when you take this one off the table.

Sure it's not a right. Neither are roads, or water, or electricity. But life is better when you have them.

That's all I'd argue. Universal health care just makes a whole lot of simple, basic, practical sense, whether it's a right or not. It just makes for a better life for everybody.

Yours is one of the wisest comments I’ve ever read here on the issue. But Americans will never understand. As I once said whatever problems and sufferings their health care system causes for them they deserve every bit of it. Maybe when they will have suffered enough they will understand what others understood 50 or more years ago. As the saying goes, a wise man learns from others’ mistakes, a fool learns from his own.

I'm here to join in the Brit above who commented that all this sounds so strange to Brits. It sounds strange to a Canadian, too. Here's the deal: around here, health care is just not an issue. We don't argue about it (much); we don't talk about it; we don't worry about it. It just happens.

Nobody goes bankrupt. Nobody goes without.

I'm well into the 1%, at least in terms of assets, and I pay substantial taxes, but I really think this is money well spent. Why? Because nobody around here, not my employees, not me, not my relatives, not the people I meet on the street, ever has to worry about health care.

You know the only time I have to agonize over a medical bill? When I take my dog to the vet. That's bad enough for me. I can't imagine what it would be like if I had to do that for a family member.

There are enough problems in life. You guys just don't see how much easier life is when you take this one off the table.

Sure it's not a right. Neither are roads, or water, or electricity. But life is better when you have them.

That's all I'd argue. Universal health care just makes a whole lot of simple, basic, practical sense, whether it's a right or not. It just makes for a better life for everybody.

Eventually some form of a single-payer system will emerge in America. In essence it’ll become Universal Medicare, with some kind of a lifetime cap. Is it the answer? No. When it comes to health care financing (and forget the word “insurance” because you can’t insure a person’s health) the free market system is simply not very efficient. Though I am a small-government person, I don’t see any other way out of what has become a hopeless mess.

If food, housing, and clothing are rights, then EVERYONE should have rights to them. Even rich people. But rich people don’t have rights to food, housing, and clothes. They can pay for those needs, so they must spend their own money. Those needs are offered as benefits only to those who can’t afford them.

That’s the difference between need and right. The right to vote means everyone, rich and poor, has the right to vote. It applies to all.

In contrast, a need is expected to be paid for by individuals. It is offered as a benefit only to those who can’t afford things of basic need.

Food, clothing, and housing are more essential than medicine. One can go for many yrs without seeing a doctor. I haven’t seen one in over 12 yrs.
But try living without food, clothing, and shelter(esp in cold areas) for a few days.
So, in a way, since food, clothing and housing are more essential to life, one could argue that it is wrong to PROFIT off them. How care anyone profit off something so crucial to life?
Indeed, communists made just that argument.
But as things turned out, the modern world created more food, clothing, and housing by profitizing their production and distribution.
So, the majority of Americans can pay for those things, and those who can’t are offered basics of housing, food, and clothing as needs.

Could the same approach be made with healthcare, especially as robotic will take over the role of so many doctors and bring down medical costs?

The "right" to medical care is a claim on somebody else's labor, not a right.

Lol what isn’t a right on someone else’s labor, what right does the IRS have to tax my labor what right does the state or county have to tax my labor, or is what your saying is that the government has a right to my labor and no one else.Hmm strange way of thinking methinks..

I'm here to join in the Brit above who commented that all this sounds so strange to Brits. It sounds strange to a Canadian, too. Here's the deal: around here, health care is just not an issue. We don't argue about it (much); we don't talk about it; we don't worry about it. It just happens.

Nobody goes bankrupt. Nobody goes without.

I'm well into the 1%, at least in terms of assets, and I pay substantial taxes, but I really think this is money well spent. Why? Because nobody around here, not my employees, not me, not my relatives, not the people I meet on the street, ever has to worry about health care.

You know the only time I have to agonize over a medical bill? When I take my dog to the vet. That's bad enough for me. I can't imagine what it would be like if I had to do that for a family member.

There are enough problems in life. You guys just don't see how much easier life is when you take this one off the table.

Sure it's not a right. Neither are roads, or water, or electricity. But life is better when you have them.

That's all I'd argue. Universal health care just makes a whole lot of simple, basic, practical sense, whether it's a right or not. It just makes for a better life for everybody.

That’s all I’d argue. Universal health care just makes a whole lot of simple, basic, practical sense, whether it’s a right or not. It just makes for a better life for everybody.

Exactly. Putting economic concerns aside, private health insurers are just an utter pain to deal with. I worked at an insurance brokerage firm, and we frequently had to go back-and-forth with major insurance carriers such as Anthem, UHC, and Cigna, just to name a few. Despite having trusted representatives from each carrier who helped us resolve employees’ questions about claims, coverage, etc, it was still an aggravating and time consuming process. I can only imagine what it’s like for regular members who don’t have trusted representatives at their disposal. Oh, and getting back to economics, all these insurance representatives that review claims and determine covered services don’t work for free. Libertarians who think that the public sector has a monopoly on wasteful bureaucracy know nothing about private health insurance.

Also, I agree with the British commenter re: Constitution fetishization. Somehow, this hallowed document hasn’t stopped the NSA from spying on us, the US from maintaining hundreds of military bases around the world, the assault on Habeas Corpus, civil asset forfeiture, or various other abuses of power. If THE CONSTITUTION is simply whatever five unelected attorneys in robes say it is, then it’s no better than a piece of paper.

What Libertarians like Napolitano fail to understand is that most people don’t give a damn about “the free market,” “The Constitution,” or other Randroid/True Conservative bromides; they care about what helps them live better lives, and universal healthcare does just that. One might even say it makes the pursuit of happiness a happier process.

Agree, thanks. The case for national health care is strengthened, I think, by its various roots, multiple rationales, and its adoption by nation-states of vastly different histories and ethnicities.

I'll list just a few talking points, top-of-the-head style, unweighted, in no special order:

(1) Bismarck's Lutheran Pietism, (2) Bismarck's wanting to snatch national health from Socialists and put it within a conservative-monarchist frame, (3) Beveridge's melioration of class differences, (4) expert, authoritative cost controls, i. e., thrift, (5) continuity of care, and numerous other private private and public health reasons, (6) replace unreliable charitable ethos with guaranteed purchasing parity, (7) end "job lock" that has workers refusing job opportunities that use their best talents because they need the group health insurance of their go-nowhere job. There's plenty more.

" . . . [T]hey care about what helps them live better lives, and universal healthcare does just that." I disagree a bit there. The medically insured I know don't give a damn about anything but that group health insurance card in their sweaty palms. Unions, for example, wrongly claim credit for group health insurance, but can't explain why they sacrifice uninsured part-time workers to bargain for contractually qualifying dependents who won't see the workplace.

I am no anthropolgist, but understand that even the most primitive societies would care for their sick.

Americans, being the most advanced people on the planet, do things differently.It doesn't seem to be working very well, but then neither does America.

Throughout our history, sick and injured poor people got care in America, just as they got food and shelter. That was a choice made by their friends, family, and caregivers, not a mandate from the State. No, moneyless jackasses who had no friends did not get expensive treatments, but they got their broken legs set, their abscesses drained and their rotten teeth pulled. Once you declare medical care to be a right, the Salvadorean car thief in prison has just as much right to cancer treatment as a 30 year old American mother of four. And the tax-paying husband of the mother of four will have to pay for it.

That’s all I’d argue. Universal health care just makes a whole lot of simple, basic, practical sense, whether it’s a right or not. It just makes for a better life for everybody.

Exactly. Putting economic concerns aside, private health insurers are just an utter pain to deal with. I worked at an insurance brokerage firm, and we frequently had to go back-and-forth with major insurance carriers such as Anthem, UHC, and Cigna, just to name a few. Despite having trusted representatives from each carrier who helped us resolve employees' questions about claims, coverage, etc, it was still an aggravating and time consuming process. I can only imagine what it's like for regular members who don't have trusted representatives at their disposal. Oh, and getting back to economics, all these insurance representatives that review claims and determine covered services don't work for free. Libertarians who think that the public sector has a monopoly on wasteful bureaucracy know nothing about private health insurance.

Also, I agree with the British commenter re: Constitution fetishization. Somehow, this hallowed document hasn't stopped the NSA from spying on us, the US from maintaining hundreds of military bases around the world, the assault on Habeas Corpus, civil asset forfeiture, or various other abuses of power. If THE CONSTITUTION is simply whatever five unelected attorneys in robes say it is, then it's no better than a piece of paper.

What Libertarians like Napolitano fail to understand is that most people don't give a damn about "the free market," "The Constitution," or other Randroid/True Conservative bromides; they care about what helps them live better lives, and universal healthcare does just that. One might even say it makes the pursuit of happiness a happier process.

Agree, thanks. The case for national health care is strengthened, I think, by its various roots, multiple rationales, and its adoption by nation-states of vastly different histories and ethnicities.

I’ll list just a few talking points, top-of-the-head style, unweighted, in no special order:

(1) Bismarck’s Lutheran Pietism, (2) Bismarck’s wanting to snatch national health from Socialists and put it within a conservative-monarchist frame, (3) Beveridge’s melioration of class differences, (4) expert, authoritative cost controls, i. e., thrift, (5) continuity of care, and numerous other private private and public health reasons, (6) replace unreliable charitable ethos with guaranteed purchasing parity, (7) end “job lock” that has workers refusing job opportunities that use their best talents because they need the group health insurance of their go-nowhere job. There’s plenty more.

” . . . [T]hey care about what helps them live better lives, and universal healthcare does just that.” I disagree a bit there. The medically insured I know don’t give a damn about anything but that group health insurance card in their sweaty palms. Unions, for example, wrongly claim credit for group health insurance, but can’t explain why they sacrifice uninsured part-time workers to bargain for contractually qualifying dependents who won’t see the workplace.

Lol what isn't a right on someone else's labor, what right does the IRS have to tax my labor what right does the state or county have to tax my labor, or is what your saying is that the government has a right to my labor and no one else.Hmm strange way of thinking methinks..

The IRS does not have rights, it has powers. Including the power to take your money and spend it on hip replacement for imprisoned Salvadorean drug runners. Because it’s their “right”.

Basic medical care has been available to most people in America for decades over a century. But the elaborate procedures available today are not affordable for everyone, any more than space flight is. You’re all going to die anyway. Live clean and healthy lives, and don’t complain because you’ve got diabetes or you’re knees are giving out because you’ve been forty pounds overweight for 30 years. If you make it to eighty and have no dementia, good for you.
And if you have the means to afford a heart transplant, good for you too. Just don’t take my (very limited) money to pay for it.

Furthermore: When you have a number of sub-populations that are dragging your country down with their antics, wasting limited resources on saving them from themselves is poor policy.

Mr. Napolitano offers an excellent outline of the libertarian position on this issue. Fine. But if he really hopes to persuade people, he (like so many other fundamentalists of liberty) should learn to at least listen to the desires of the people he's trying to persuade. The Obamacare bill was advertised as trying to remedy many unpleasant things that many Americans really don't want: getting excluded from coverage for pre-existing conditions et cetera. Napolitano's policy may indeed be the best for America, but it will never be adopted if he and its other proponents never learn to escape the implausible (at least to nonbelievers) notion that What-The-Market-Decides = What-Is-Good.

Obamacare was a way to redistribute resources via government edict without using the tax system.

It’s simply sold as socializing the costs of illness and injury, but does so by feeding a vast industrial cartel.

Those here who argue in favor of a government-run monopoly over medical services obviously know nothing about why centrally planned systems always fail.

That said, the problems of today emanate from cartelization of all medical services going back to WW2. There are too many people involved, and the divorce between the payer and the beneficiary of services yields a host of perverse incentives causing untold harm and insane costs.

It is strange that those who proclaim the “right to life” exists when abortion is considered as a way to end an unwanted pregnancy are not quite so enthusiastic about the right to stay alive when it involves expenditure on behalf of those who cannot afford it for themselves.

Presumably different parts of the brain are involved in dealing with the two concepts, and many prolifers on abortion are racked with guilt over some personal misdemeanor buried in history or the subconscious.

The right to not be killed and the right to force somebody else to pay for your medical care are easily distinguished by using one's reason, whatever part of the brain that resides in. You may have a different view on the matter, working from different assumptions, but your statement that the two concepts involve different parts of the brain is clearly rooted in premature toilet training.

I'm here to join in the Brit above who commented that all this sounds so strange to Brits. It sounds strange to a Canadian, too. Here's the deal: around here, health care is just not an issue. We don't argue about it (much); we don't talk about it; we don't worry about it. It just happens.

Nobody goes bankrupt. Nobody goes without.

I'm well into the 1%, at least in terms of assets, and I pay substantial taxes, but I really think this is money well spent. Why? Because nobody around here, not my employees, not me, not my relatives, not the people I meet on the street, ever has to worry about health care.

You know the only time I have to agonize over a medical bill? When I take my dog to the vet. That's bad enough for me. I can't imagine what it would be like if I had to do that for a family member.

There are enough problems in life. You guys just don't see how much easier life is when you take this one off the table.

Sure it's not a right. Neither are roads, or water, or electricity. But life is better when you have them.

That's all I'd argue. Universal health care just makes a whole lot of simple, basic, practical sense, whether it's a right or not. It just makes for a better life for everybody.

Sure it’s not a right. Neither are roads, or water, or electricity. But life is better when you have them.

That’s right. And you can add in garbage disposal. Having spent some time in Haiti, I can vouch for what “small government” really looks like when taken to its logical extreme. After the earthquake in 2010 I was able to clamber around in the ruins of destroyed buildings, see corpses everywhere, and never saw a single piece of yellow plastic tape or a police car, except one time I saw a UN armored car causing a traffic jam by driving on the wrong side of a divided highway, and Anderson Cooper causing a minor traffic jam.

It is strange that those who proclaim the "right to life" exists when abortion is considered as a way to end an unwanted pregnancy are not quite so enthusiastic about the right to stay alive when it involves expenditure on behalf of those who cannot afford it for themselves.

Presumably different parts of the brain are involved in dealing with the two concepts, and many prolifers on abortion are racked with guilt over some personal misdemeanor buried in history or the subconscious.

The right to not be killed and the right to force somebody else to pay for your medical care are easily distinguished by using one’s reason, whatever part of the brain that resides in. You may have a different view on the matter, working from different assumptions, but your statement that the two concepts involve different parts of the brain is clearly rooted in premature toilet training.

Throughout our history, sick and injured poor people got care in America, just as they got food and shelter. That was a choice made by their friends, family, and caregivers, not a mandate from the State. No, moneyless jackasses who had no friends did not get expensive treatments, but they got their broken legs set, their abscesses drained and their rotten teeth pulled. Once you declare medical care to be a right, the Salvadorean car thief in prison has just as much right to cancer treatment as a 30 year old American mother of four. And the tax-paying husband of the mother of four will have to pay for it.

So it’s all El Salvador’s fault. I used to think it was due to US medical costs being double those elsewhere,
but apparently not.

But the costs have skyrocketed in the past 50-60 years; you didn't have the same discrepancy back then. Programs like Medicare are largely responsible for the explosion in costs. Other countries like England can hold down costs, but in those cases they just act like price controls do elsewhere and create shortages, hence the notorious waiting lists in the NHS.

Free healthcare for all is obviously something we want, just like we want free food, free housing, free everything. Wanting it doesn't make it so, however.

Hm, I don't think federalism entails the notion that rights are granted by governments (whether federal or state). All people have the same rights, but the idea behind federalism is that it's up to the people of each state to determine how many powers they're willing to cede to their governments; it's not the place of the federal government to make that decision for them (which is what the "incorporation doctrine" of the federal Bill of Rights claims).

Even if a government offers universal coverage to all its citizens, that still doesn't make healthcare a right. If you accept a social contract theory of government, you could say that the people granted their governments the power to provide such a service, but a government can't just conjure new rights into existence.

Health care services are a civil right if the majority of people in each US state say it is a right, and the same majority of people vote to make it a state peculiar law.

The US constitution supports the idea of state-run health care, but it doesn't endorse federal-run health care.

National socialist in the US don't like the idea of state-run health care because it would slow their constant scheming to Israel-ize the US.

Hm, I don’t think federalism entails the notion that rights are granted by governments (whether federal or state). All people have the same rights, but the idea behind federalism is that it’s up to the people of each state to determine how many powers they’re willing to cede to their governments; it’s not the place of the federal government to make that decision for them (which is what the “incorporation doctrine” of the federal Bill of Rights claims).

Even if a government offers universal coverage to all its citizens, that still doesn’t make healthcare a right. If you accept a social contract theory of government, you could say that the people granted their governments the power to provide such a service, but a government can’t just conjure new rights into existence.

Mr. Napolitano offers an excellent outline of the libertarian position on this issue. Fine. But if he really hopes to persuade people, he (like so many other fundamentalists of liberty) should learn to at least listen to the desires of the people he's trying to persuade. The Obamacare bill was advertised as trying to remedy many unpleasant things that many Americans really don't want: getting excluded from coverage for pre-existing conditions et cetera. Napolitano's policy may indeed be the best for America, but it will never be adopted if he and its other proponents never learn to escape the implausible (at least to nonbelievers) notion that What-The-Market-Decides = What-Is-Good.

The problem is that for most people What-Is-Good = What-Is-My-Right. But merely wanting or even needing something does not entail a right to it. Sadly, this is not recognized by our leaders. Witness all the positive “rights” to the labor of others listed in the UN declaration of human rights.

The Constitution apparently mandates gay marriage and a recently discovered right of non-citizens to be free from religious discrimination when they apply for a visa. The Constitution apparently permits Departments of Education, Labor, Commerce, Energy, Transportation, standing armies, indiscriminate spying on citizens, etc.

I am not concerned with Constitutional arguments at this point. The Constitution means whatever the government wants it to mean.

We have socialized medical coverage for old people, poor people, the military, and federal, state and municipal employees. What is the argument against extending some level of medical coverage to everybody else, like the rest of the industrialized world does?

Perhaps a lot of people don’t want socialized medicine since it results in long waiting times and shortages. Why otherwise do Canadians come to the US to get timely medical service and avoid the waits in their socialist paradise? The problem is that healthcare is a scarce good and merely labeling it a right doesn’t alter that fact. There is not enough to go around for everybody, so you either let the price system determine how to allocate resources or you let the government ration it.

I am no anthropolgist, but understand that even the most primitive societies would care for their sick.

Americans, being the most advanced people on the planet, do things differently.It doesn't seem to be working very well, but then neither does America.

You do realize that it’s possible to care for your sick without declaring that the sick have a right to care, right? And also that in “primitive societies” it was usual to abandon infants and the elderly and others that were a burden on others, just as in Britain people are put on long waiting lists to receive care if the government decides they are not a priority.

Healthcare can’t be a right because it’s a scarce good. There isn’t enough to satisfy everybody’s wants or needs, so if the system runs out of resources, it does no good to complain that you have a “right” to a service that simply does not exist.

I'm here to join in the Brit above who commented that all this sounds so strange to Brits. It sounds strange to a Canadian, too. Here's the deal: around here, health care is just not an issue. We don't argue about it (much); we don't talk about it; we don't worry about it. It just happens.

Nobody goes bankrupt. Nobody goes without.

I'm well into the 1%, at least in terms of assets, and I pay substantial taxes, but I really think this is money well spent. Why? Because nobody around here, not my employees, not me, not my relatives, not the people I meet on the street, ever has to worry about health care.

You know the only time I have to agonize over a medical bill? When I take my dog to the vet. That's bad enough for me. I can't imagine what it would be like if I had to do that for a family member.

There are enough problems in life. You guys just don't see how much easier life is when you take this one off the table.

Sure it's not a right. Neither are roads, or water, or electricity. But life is better when you have them.

That's all I'd argue. Universal health care just makes a whole lot of simple, basic, practical sense, whether it's a right or not. It just makes for a better life for everybody.

I agree with you about dropping the silly “rights” rhetoric and simply regard healthcare as a good that could be paid for by government rather than private providers. However, I think you are empirically mistaken when you say that nobody in Canada goes without healthcare. Did you know that many Canadians travel to the US to get healthcare because they cannot get certain services in Canada, or have to wait too long to get those services? This is to be expected, because healthcare is a scarce good; there is not ever enough to satisfy everybody’s wants. Either the market allocates the scarce resources through the pricing mechanism, or the government has to use some rationing scheme, which includes denying some services or forcing people to wait for others.

I honestly think much of this superiority you feel about the Canadian system comes from the illusion that you have universal care. You don’t. You have universal coverage which means that, if the government decides to let you use a service, you will not be billed for it directly. Now I can see how that provides some psychological relief and sense of security, but don’t pretend that it’s something it’s not.

Yes, there are credible accounts of Canadians waiting for treatment for elective and non-emergent conditions, and rationing to the point of extinction of me-too drugs that fail to meet the better than existing pharmacopoeia standard, but readily pass the FDA's better than placebo standard, which makes newer but not better drugs in the States very profitable.

Canadians use health care facilities in the United States. So do foreign nationals who are legal permanent residents of the United States, or stay for extended periods in the States for work, study, or retirement. Americans, as well, use health care facilities in other countries, and the phenomenon of "medical tourism" is pretty much a known thing. There's at least one large Canadian clinic that used to regularly advertise for patients in two northern Ohio newspapers.

Not sure about "scarce good". At one local employer, workers pay a dime on a dollar toward the cost of their group health insurance enrollment, and an ER visit costing thousands is billed to them at a flat $75. Medicine for them is not scarce at all, but "super-abundant".

So it's all El Salvador's fault. I used to think it was due to US medical costs being double those elsewhere,
but apparently not.

But the costs have skyrocketed in the past 50-60 years; you didn’t have the same discrepancy back then. Programs like Medicare are largely responsible for the explosion in costs. Other countries like England can hold down costs, but in those cases they just act like price controls do elsewhere and create shortages, hence the notorious waiting lists in the NHS.

Free healthcare for all is obviously something we want, just like we want free food, free housing, free everything. Wanting it doesn’t make it so, however.

I agree with you about dropping the silly "rights" rhetoric and simply regard healthcare as a good that could be paid for by government rather than private providers. However, I think you are empirically mistaken when you say that nobody in Canada goes without healthcare. Did you know that many Canadians travel to the US to get healthcare because they cannot get certain services in Canada, or have to wait too long to get those services? This is to be expected, because healthcare is a scarce good; there is not ever enough to satisfy everybody's wants. Either the market allocates the scarce resources through the pricing mechanism, or the government has to use some rationing scheme, which includes denying some services or forcing people to wait for others.

I honestly think much of this superiority you feel about the Canadian system comes from the illusion that you have universal care. You don't. You have universal coverage which means that, if the government decides to let you use a service, you will not be billed for it directly. Now I can see how that provides some psychological relief and sense of security, but don't pretend that it's something it's not.

Yes, there are credible accounts of Canadians waiting for treatment for elective and non-emergent conditions, and rationing to the point of extinction of me-too drugs that fail to meet the better than existing pharmacopoeia standard, but readily pass the FDA’s better than placebo standard, which makes newer but not better drugs in the States very profitable.

Canadians use health care facilities in the United States. So do foreign nationals who are legal permanent residents of the United States, or stay for extended periods in the States for work, study, or retirement. Americans, as well, use health care facilities in other countries, and the phenomenon of “medical tourism” is pretty much a known thing. There’s at least one large Canadian clinic that used to regularly advertise for patients in two northern Ohio newspapers.

Not sure about “scarce good”. At one local employer, workers pay a dime on a dollar toward the cost of their group health insurance enrollment, and an ER visit costing thousands is billed to them at a flat $75. Medicine for them is not scarce at all, but “super-abundant”.

I was using "scarce" in a technical economic sense of a good whose supply is limited in the absolute; scarcity distinguishes healthcare from something like air, which from an economic point of view is not scarce, since there is currently enough to satisfy all human wants without having to be rationed or priced. Whether or not healthcare is scarce relative to other goods is another question, of course.

Yes, there are credible accounts of Canadians waiting for treatment for elective and non-emergent conditions, and rationing to the point of extinction of me-too drugs that fail to meet the better than existing pharmacopoeia standard, but readily pass the FDA's better than placebo standard, which makes newer but not better drugs in the States very profitable.

Canadians use health care facilities in the United States. So do foreign nationals who are legal permanent residents of the United States, or stay for extended periods in the States for work, study, or retirement. Americans, as well, use health care facilities in other countries, and the phenomenon of "medical tourism" is pretty much a known thing. There's at least one large Canadian clinic that used to regularly advertise for patients in two northern Ohio newspapers.

Not sure about "scarce good". At one local employer, workers pay a dime on a dollar toward the cost of their group health insurance enrollment, and an ER visit costing thousands is billed to them at a flat $75. Medicine for them is not scarce at all, but "super-abundant".

I was using “scarce” in a technical economic sense of a good whose supply is limited in the absolute; scarcity distinguishes healthcare from something like air, which from an economic point of view is not scarce, since there is currently enough to satisfy all human wants without having to be rationed or priced. Whether or not healthcare is scarce relative to other goods is another question, of course.

The federal government takes in annual revenue of $3.6T a year. The total for all states is $2T and municipal is $1.4T. Out of all that, we manage to fund the healthcare of the poor, the elderly and all government employees. This is just an issue of priorities and policy.

Perhaps a lot of people don't want socialized medicine since it results in long waiting times and shortages. Why otherwise do Canadians come to the US to get timely medical service and avoid the waits in their socialist paradise? The problem is that healthcare is a scarce good and merely labeling it a right doesn't alter that fact. There is not enough to go around for everybody, so you either let the price system determine how to allocate resources or you let the government ration it.

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